154 - NINTH REPORT. 



SEPTIC SURGICAL INFECTIONS. 



Palmar Abscess. — A case of palmar abscess in a man was referred to me 

 by Dr. George Sherman of Detroit. The hand and forearm were greatly- 

 swollen; a deep abscess was present in the center of the palm under the point 

 of infection and much constitutional disturbance was in evidence. Two in- 

 jections of streptolytic serum had produced no effect further than to lower 

 the temperature, and Dr. Sherman made a small incision in the palm and 

 brought me some of the pus in a sterile syringe. Immediate smears from 

 the pus showed staphylococci and the first dose of 100 millions stock staphy- 

 lococcus aureus opsonogen was injected. A halt in the progress began in 

 24 hours and in three days the improved general condition was accompanied 

 by a reduction in the swelling. From the pus Staphylococcus alhus in pure 

 culture was obtained and an opsonogen prepared; the fourth inoculation 

 with the autogenous bacteria in a dose of 150 millions was performed. The 

 improvement became more pronounced, the suppuration more superficial, 

 and an incision H inches in length extending the original one was all that 

 was recjuired. Two more inoculations with the autogenous opsonogen in 

 doses of 200 millions at intervals of a week completed the perfect recovery 

 of this infection, with full healing of the incision and no impairment in the 

 functional perfection of the hand. 



Since this first experience I have treated several cases in which infection 

 followed accidental or surgical injury to the fingers, hands or feet. Various 

 grades of the infective process, from a localized inflammatory reaction in 

 the neighborhood of the original focus of injury or operation to those in which 

 spreading inflammatory oedema extended well up the arm or leg have been 

 attempted. In all of these cases the invading microorganisms happened to 

 belong to the group of staphylococci, and prompt, satisfactory arrest of the 

 inflammatory process and early recovery without the usual suppuration 

 and prolonged treatment by incisions, drainage, and antiseptics was brought 

 about by the use of proper doses of opsonogens of autogenous origin. These 

 cases have been seen in consultation with various Detroit physicians in pri- 

 vate practice, and several have occurred in the surgical service of Dr. Theo. 

 McGraw at St. Mary's Hospital. 



Urinary Infection.— As an example of the truly astonishing results one 

 may obtain by bacterial therapy properly applied I will again refer to my 

 first case of colon bacillus infection. The patient was a retired physician 

 afflicted with locomotor ataxia and consec^uent palsy of the bladder, fol- 

 lowed by an infection of the bladder and the usual ascending urinary infec- 

 tion, producing a cystitis and pyelo-nephrosis and of three months' duration. 

 The ordinary lines of medical treatment, including the use of urotropin hatl 

 failed to bring relief, as had likewise such procedures as irrigation of the 

 bladder with various antiseptic solutions; and the patient was bed-ridden, 

 emaciated, profoundly septic with its usual train of anorexia, constipation, 

 vomiting and j^rostration. The urine was foul in odor and loaded with thick, 

 greenish-yellow, gelatinous pus which in a pint of urine settled to a layer one 

 inch in depth. Chills, a daily temperature of 103 F., and profuse night 

 sweats were established. The right kidney was plainly palpable and on its 

 ventral surface one could feel a mass as large as a lemon, tender and appar- 

 ently representing the dilated urinary pelvis. According to precedent 

 such a case would of course be pronounced incurable, and except from the 

 standpoint of endeavoring to make the remaining existence endurable, would 

 be abandoned. I was called in consultation by Dr. Chas. D. Aaron, who 



